MAPD Chargebacks for Deceased?

Jun 14, 2016

  1. fostever
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    fostever Guru

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    I have a carrier that is charging back when any of my long time enrolled MAPD customers die. So I get a prorated chargeback when they drop off the books. I've never had this happen before last year and wonder if this is new or even correct? Anyone know where to find the CMS guidelines on this?:mad:
     
    fostever, Jun 14, 2016
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  2. vic120
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    vic120 Guru

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    Not sure why that would be if 2nd year is paying as earned, Unless they are for some reason paying you years 2+ the year upfront,Then it would makes sense because most pay years 2+ as earned
     
    vic120, Jun 14, 2016
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  3. yogooglethis
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    are you sure it isn't renewals paid out after death that they are recovering? this has happened to me but to answer your question there should be no charge back as long as there are no advances outstanding.
     
  4. grod
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    grod Super Genius

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    I've had it happen to me. They've paid renewal commissions for months past the deceased date. Eventually the plan finds out and they stop paying you renewals, plus they collect anything they have paid you since then. I've had one go back for over one year and collect. I called the company to ask about it and they simply say they do the best they can. But yes, they definitely collect.
     
    grod, Jun 14, 2016
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  5. fostever
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    fostever Guru

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    Last year they switched to as earned and I was recieving a deposit $17/ enrollee per month. Then for 2016 they said CMS guidance required renewals to be advanced in Jan. 2016. So this is a prorated chargeback. Anyway, I for some reason thought in the 10 years of writing MAPD plans that death was not reason for a chargeback since it was never listed on any commission reports. Thanks for clarifying. I prefer as earned, but they won't give that option anymore.
     
    fostever, Jun 16, 2016
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  6. wehotex
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    wehotex Guru

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    You are correct. They didn't chargeback for those before. I had one that died in the first month of 2016 with Aetna. It wasn't a TOTAL chargeback. Aetna paid me for January and charged back 11/12 of the commission which was a Jan 2016 effective enrollment.
     
    wehotex, Jun 16, 2016
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  7. fostever
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    Last year 2015 was the first time I saw a chargeback for deceased. It's one of those CMS "change the rules as we go along" policies!:1err:
     
    fostever, Jun 28, 2016
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